院前多模式预康复对胃肠道恶性肿瘤患者术前功能及术后恢复效果的影响

doi:10.3969/j.issn.1674-8115.2024.10.003

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (10): 1229-1234.doi: 10.3969/j.issn.1674-8115.2024.10.003

• 临床护理专题 • 上一篇

院前多模式预康复对胃肠道恶性肿瘤患者术前功能及术后恢复效果的影响

台瑞¹(), 孙菊芳¹, 林英¹, 章雅青², 黄陈³, 方芳¹()

^1.上海交通大学医学院附属第一人民医院护理部，上海 200080
^2.上海交通大学护理学院，上海 200025
^3.上海交通大学医学院附属第一人民医院胃肠外科，上海 200080

收稿日期:2024-04-03 接受日期:2024-07-22 出版日期:2024-10-28 发布日期:2024-10-28
通讯作者: 方芳 E-mail:realltairui@163.com;fang_fang0604@163.com
作者简介:台瑞（1993—），女，主管护师，硕士；电子信箱：realltairui@163.com。
基金资助:
上海交通大学医学院护理学科建设项目(SJTUHLXK2022);上海市第一人民医院特色研究项目(CCTR-2022N04);上海交通大学医学院护理科研项目(Jyhz2412)

Effect of prehospital multimodal prehabilitation on preoperative function and postoperative recovery in patients with gastrointestinal malignant tumors

TAI Rui¹(), SUN Jufang¹, LIN Ying¹, ZHANG Yaqing², HUANG Chen³, FANG Fang¹()

^1.Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
^2.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
^3.Department of Gastrointestinal Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

Received:2024-04-03 Accepted:2024-07-22 Online:2024-10-28 Published:2024-10-28
Contact: FANG Fang E-mail:realltairui@163.com;fang_fang0604@163.com
Supported by:
Nursing Development Program of Shanghai Jiao Tong University School of Medicine(SJTUHLXK2022);Clinical Research Innovation Plan of Shanghai General Hospital(CCTR-2022N04);Nursing Research Program of Shanghai Jiao Tong University School of Medicine(Jyhz2412)

摘要/Abstract

摘要：

目的·探索院前多模式预康复计划对胃肠道恶性肿瘤患者术前功能状态及术后恢复效果的影响。方法·纳入2023年6月—12月上海交通大学医学院附属第一人民医院胃肠外科收治的胃肠道恶性肿瘤患者78例，采用随机数字表将其分为对照组（n=40例）和院前多模式预康复组（PMP组，n=38例）。手术前，对照组遵循常规的术前指导，PMP组接受院前多模式预康复计划。收集患者的一般资料，比较2组患者在基线及术前1 d的6分钟步行距离（6-minute walk distance，6MWD），术后住院时间、首次排气/排便时间、首次口服进食时间、首次下床活动时间及引流管拔除时间和术后并发症发生率。结果·2组患者的一般资料和术前干预的时间比较，差异无统计学意义（P>0.05）。基线时，2组患者的6MWD比较，差异无统计学意义（P>0.05）；术前1 d，PMP组的6MWD高于对照组（P=0.016）；PMP组6MWD较基线增加（23.42±13.26）m，对照组6MWD较基线减少（3.75±12.08）m（P<0.001）。PMP组患者首次排气/排便时间、首次经口进食时间以及首次下床活动时间均早于对照组（P<0.05）。2组患者术后引流管留置时间、住院天数以及并发症发生率的差异无统计学意义（P>0.05）。结论·院前多模式预康复能够提高胃肠道恶性肿瘤患者术前的功能并且加快其术后恢复。

关键词: 胃肠道手术, 多模式预康复, 围术期, 功能能力, 术后恢复

Abstract:

Objective ·To explore the effect of a prehospital multimodal prehabilitation program on the preoperative functional status and postoperative recovery of patients with gastrointestinal malignant tumors. Methods ·A total of 78 patients with gastrointestinal malignant tumors, hospitalized in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from June to December 2023, were enrolled. They were divided into the standard group (SD group, n=40) and the prehospital multimodal prehabilitation group (PMP group, n=38) by using random number table. From the time the operation was agreed upon by both the doctor and patient to the day before the operation, the SD group followed the routine preoperative guidance, while the PMP group received a home-based prehospital multimodal prehabilitation program. The general data of patients were collected, and the six-minute walk distance (6MWD) was compared between the two groups at baseline and on the day before operation.The length of postoperative hospitalization, time to first flatus, time to first ambulation, time to first oral intake, drainage removal time and postoperative complication rate were also compared between the two groups. Results ·There was no difference in general data and duration of preoperative intervention of patients between the two groups. At baseline, there was no significant difference in 6MWD between the two groups. On the day before operation, the 6MWD in the PMP group was higher than that in the SD group (P= 0.016). Changes in 6MWD in the PMP group were significantly higher compared to SD group during the preoperative period, with values of (23.42±13.59) m vs. (-3.75±12.08) m (P<0.001). Time to first flatus, time to first ambulation and time to first oral intake in the PMP group were earlier than those in the SD group (P<0.05). However, there was no significant difference in drainage removal time, postoperative hospitalization and postoperative complication rate between the two groups (P>0.05). Conclusion ·Prehospital multimodal prehabilitation can improve the preoperative function and accelerate the postoperative recovery in patients with gastrointestinal malignancies.

Key words: gastrointestinal surgery, multimodal prehabilitation, perioperative, functional capability, postoperative recovery

中图分类号:

R473.6

台瑞, 孙菊芳, 林英, 章雅青, 黄陈, 方芳. 院前多模式预康复对胃肠道恶性肿瘤患者术前功能及术后恢复效果的影响[J]. 上海交通大学学报（医学版）, 2024, 44(10): 1229-1234.

TAI Rui, SUN Jufang, LIN Ying, ZHANG Yaqing, HUANG Chen, FANG Fang. Effect of prehospital multimodal prehabilitation on preoperative function and postoperative recovery in patients with gastrointestinal malignant tumors[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1229-1234.

图/表 3

参考文献 21

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Item	SD group (n=40)	PMP group (n=38)	t/χ² value	P value
Age/year	66.52±9.26	67.82±9.17	-0.618	0.538
BMI/(kg·m^-2)	23.22±2.93	24.40±4.00	-1.493	0.140
Gender/n(%)			0.435	0.509
Male	23 (57.4)	19 (50.0)
Female	17 (42.6)	19 (50.0)
Registered residence/n(%)			0.503	0.478
City	35 (87.5)	31 (81.6)
Town	2 (5.0)	3 (7.9)
Country	3 (7.5)	4 (10.5)
Education/n(%)			1.528	0.216
Junior high and below	24 (60.0)	27 (71.0)
Technical secondary school/senior high school	9 (22.5)	9 (23.6)
Junior college	6 (15.0)	1 (2.7)
Bachelor's degree or above	1 (2.5)	1 (2.7)
Tumor site/n(%)			1.185	0.276
Gastric cancer	14 (35.0)	9 (32.1)
Colorectal cancer	26 (65.0)	29 (67.9)
Hypertension/n(%)			2.466	0.116
Yes	16 (40.0)	22 (57.9)
No	24 (60.0)	16 (45.1)
Diabetes mellitus/n(%)			1.140	0.286
Yes	9 (22.5)	5 (13.2)
No	31 (77.5)	33 (86.8)
Other comorbidity/n(%)			1.233	0.267
Yes	5 (12.5)	2 (5.3)
No	35 (87.5)	36 (94.7)
Duration of prehabilitation/d	6.90±1.11	7.05±1.06	-0.412	0.681

Item	SD group (n=40)	PMP group (n=38)	t/χ² value	P value
Age/year	66.52±9.26	67.82±9.17	-0.618	0.538
BMI/(kg·m^-2)	23.22±2.93	24.40±4.00	-1.493	0.140
Gender/n(%)			0.435	0.509
Male	23 (57.4)	19 (50.0)
Female	17 (42.6)	19 (50.0)
Registered residence/n(%)			0.503	0.478
City	35 (87.5)	31 (81.6)
Town	2 (5.0)	3 (7.9)
Country	3 (7.5)	4 (10.5)
Education/n(%)			1.528	0.216
Junior high and below	24 (60.0)	27 (71.0)
Technical secondary school/senior high school	9 (22.5)	9 (23.6)
Junior college	6 (15.0)	1 (2.7)
Bachelor's degree or above	1 (2.5)	1 (2.7)
Tumor site/n(%)			1.185	0.276
Gastric cancer	14 (35.0)	9 (32.1)
Colorectal cancer	26 (65.0)	29 (67.9)
Hypertension/n(%)			2.466	0.116
Yes	16 (40.0)	22 (57.9)
No	24 (60.0)	16 (45.1)
Diabetes mellitus/n(%)			1.140	0.286
Yes	9 (22.5)	5 (13.2)
No	31 (77.5)	33 (86.8)
Other comorbidity/n(%)			1.233	0.267
Yes	5 (12.5)	2 (5.3)
No	35 (87.5)	36 (94.7)
Duration of prehabilitation/d	6.90±1.11	7.05±1.06	-0.412	0.681

Variable	SD group (n=40)	PMP group (n=38)	t value	P value
6MWD/m
Baseline	405.50±48.95	406.05±42.30	-0.053	0.958
Preoperative	401.75±50.91	429.47±48.10	-2.469	0.016
Changes of 6MWD from baseline /m	-3.75±12.08	23.42±13.26	-9.470	<0.001

Variable	SD group (n=40)	PMP group (n=38)	t value	P value
6MWD/m
Baseline	405.50±48.95	406.05±42.30	-0.053	0.958
Preoperative	401.75±50.91	429.47±48.10	-2.469	0.016
Changes of 6MWD from baseline /m	-3.75±12.08	23.42±13.26	-9.470	<0.001

Variable	SD group (n=40)	PMP group (n=38)	t/χ² value	P value
Length of postoperative hospitalization /d	8.71±2.56	8.42±3.13	0.471	0.639
Time to first flatus/d	3.13±0.99	2.58±1.03	2.385	0.020
Time to first oral intake/d	3.25±1.46	2.42±1.52	2.456	0.016
Time to first ambulation/d	3.63±1.00	2.76±0.75	4.273	<0.001
Drainage removal time/d	7.85±2.65	7.89±2.76	-0.074	0.941
Patients with complications/n(%)			3.738	0.053
Yes	8 (20.0)	3 (7.9)
No	32 (80.0)	35 (92.1)

院前多模式预康复对胃肠道恶性肿瘤患者术前功能及术后恢复效果的影响

Effect of prehospital multimodal prehabilitation on preoperative function and postoperative recovery in patients with gastrointestinal malignant tumors

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